Urinary Incontinence

Urinary incontinence refers to involuntary urination or loss of control on bladder. It is a very common problem among the elderly. The severity of this ranges from leaking urine while coughing or sneezing, to having a strong, sudden and uncontrollable urge to urinate at any time. Normal aging is not a cause for urinary incontinence, unless the bladder muscles become weaker. Urinary incontinence may be temporary or chronic, depending on its cause. Studies show that urinary incontinence is prevalent among elderly women.

< Occasional minor leaks of urine
< Urine leaks while exerting pressure on the bladder by coughing, sneezing, laughing, exercising, etc.
< Experience of frequent dribbling of urine due to bladder that does not empty completely

< Stress incontinence is due to excessive pressure on the bladder or the loss of support of the urethra.
< Urge incontinence is caused by the inhibited contraction of sphincter muscles.
< Polyuria, which means excessive production of urine, is caused by uncontrolled diabetes and excessive fluid intake. This also leads to urine incontinence.
< An enlarged prostate is the most common cause in men above 40 years of age. Diseases like Parkinson’s, strokes and spinal injury can interfere with the nerve function of the urinary bladder.

Urinary incontinence is divided into three categories:

Stress incontinence
This occurs when a patient coughs, sneezes, exercises, laughs or participates in a similar physical activity. Such activities put abdominal pressure on the bladder. Emotional stress is not a factor in this kind of urinary disorder and the term ‘stress’ refers to excessive pressure on the bladder.

Urge incontinence
This occurs when the patient has sudden, uncontrollable and strong urge to urinate. In this case, the bladder contracts when it should not and causes urine to leak through the sphincter muscle. This condition can affect one’s daily life and also cause some infections.

Overflow incontinenceThis happens when the patient is unable to empty the bladder completely, causing leakage when the bladder is full. A few reasons for overflow incontinence are constipation, weak bladder muscles, blockage of urethra or other medical conditions.

Diagnosis depends on the type of urinary incontinence affecting the patient. The doctor is likely to start by asking for a thorough history and getting a physical examination. The doctor may also recommend the following:

< Post-void residual measurement – Doctor may measure the urine output and then check the amount of leftover urine in the bladder via ultrasound
< Urinalysis – Doctor may check a sample of the urine for traces of blood or infection
< Self-record – Doctor may ask to maintain a record of liquid intake and urination patterns and levels

Treatment for urinary incontinence depends on its type and severity. Doctor may suggest the following treatments:

< Fluid and diet management – This includes avoiding alcohol, caffeine or acidic food. Reducing liquid consumption, losing weight and increasing physical activity also helps.
< Double voiding – Double voiding means urinating, waiting for some time and then trying again. This helps to avoid overflow incontinence.
< Scheduling toilet trips – The patient may be required to try to urinate at a scheduled time rather than waiting for the urge.
< Toilet training – This involves training the bladder to control the urge to urinate at least for 10 minutes.
< Pelvic floor exercises – These can help strengthen the muscle to control the urge to urinate.
< Electrical stimulation – Electrodes are inserted in the rectum or vagina to strengthen and stimulate the muscles.

Listed below are some medications commonly used to treat urinary incontinence.

< Anticholinergics: To calm an overactive bladder
< Mirabegron: To relax the bladder muscles and increase the amount of urine the bladder can hold
< Alpha blockers: To relax bladder neck muscles and make it easier to empty bladder
< Topical estrogen: To help in reducing the symptoms of incontinence

Below are some tips for caring for a person affected by urinary incontinence.

Pelvic floor exercises – Encourage the patient to do pelvic floor exercises. This will help control the urge to urinate and also strengthen the muscle.
Fluid management – Limit the patient’s intake of alcohol and caffeine and encourage them to drink 6-8 glasses of water per day.
Wearable devices – Placing a support to the vagina can help prevent leaks. Adult diapers may also be used.
Weight loss – Excess weight can lead to leaks because of pressure to the bladder. Losing weight can help keep this in control.
Bathroom Schedule – Create a bathroom schedule for the patient. Urinating every 2-3 hours, instead of waiting for the urge may help.

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